Validation of bladder health scales and function indices for women's research

Melissa L Constantine; Todd H Rockwood; Leslie M Rickey; Tamara Bavendam; Lisa Kane Low; Jerry L Lowder; Alayne D Markland; Gerald McGwin; Elizabeth R Mueller; Diane K Newman; Sara Putnam; Kyle Rudser; Ariana L Smith; Ann E Stapleton; Janis M Miller; Emily S Lukacz; of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium

doi:10.1016/j.ajog.2022.12.319

Validation of bladder health scales and function indices for women's research

Am J Obstet Gynecol. 2023 May;228(5):566.e1-566.e14. doi: 10.1016/j.ajog.2022.12.319. Epub 2022 Dec 31.

Authors

Melissa L Constantine¹, Todd H Rockwood², Leslie M Rickey³, Tamara Bavendam⁴, Lisa Kane Low⁵, Jerry L Lowder⁶, Alayne D Markland⁷, Gerald McGwin⁸, Elizabeth R Mueller⁹, Diane K Newman¹⁰, Sara Putnam¹¹, Kyle Rudser¹¹, Ariana L Smith¹⁰, Ann E Stapleton¹², Janis M Miller⁵, Emily S Lukacz¹³; of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium

Collaborators

of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium:
Linda Brubaker, Elizabeth R Mueller, Msme Marian Acevedo-Alvarez, Colleen M Fitzgerald, Cecilia T Hardacker, Jeni Hebert-Beirne, Missy Lavender, James W Griffith, Kimberly Sue Kenton, Melissa Simon, Julia Geynisman-Tan, Alayne D Markland, Tamera Coyne-Beasley, Kathryn L Burgio, Cora E Lewis, Gerald McGwin Jr, Camille P Vaughan, Beverly Rosa Williams, Emily S Lukacz, Sheila Gahagan, D Yvette LaCoursiere, Jesse Nodora, Janis M Miller, Lisa Kane Low, Bernard L Harlow, Kyle D Rudser, Sonya S Brady, Haitao Chu, Melissa L Constantine, Cynthia S Fok, Peter Scal, Todd Rockwood, Diane K Newman, Ariana L Smith, Amanda Berry, Andrea Bilger, Heather Klusaritz, Terri Lipman, Ann E Stapleton, Jean F Wyman, Siobhan Sutcliffe, Aimee S James, Jerry L Lowder, Melanie R Meister, Leslie M Rickey, Marie A Brault, Deepa R Camenga, Shayna D Cunningham, Julia Barthold

Affiliations

¹ Division of Biostatistics, University of Minnesota, Minneapolis, MN; Patient Centered Research, Evidera, Bethesda, MD. Electronic address: cons0026@umn.edu.
² Department of Health Policy, University of Minnesota, Minneapolis, MN.
³ Departments of Urology and Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
⁴ National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD.
⁵ School of Nursing, University of Michigan, Ann Arbor, MI.
⁶ Department of Obstetrics and Gynecology, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO.
⁷ Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL.
⁸ School of Public Health, The University of Alabama at Birmingham, Birmingham, AL.
⁹ Departments of Urology and Obstetrics and Gynecology, Loyola University Medical Center, Loyola University Chicago, Chicago, IL.
¹⁰ Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
¹¹ Division of Biostatistics, University of Minnesota, Minneapolis, MN.
¹² Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA.
¹³ Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, La Jolla, CA. Electronic address: elukacz@ucsd.edu.

Abstract

Background: Existing bladder-specific measures lack the ability to assess the full range of bladder health, from poor to optimal health.

Objective: This study aimed to report evidence of validity of the self-administered, multidimensional bladder health scales and function indices for research in adult women.

Study design: A cross-sectional population-based validation study with random assignment to paper or electronic administration was conducted using national address-based probability sampling supplemented by purposive sampling of women with lower urinary tract symptoms in 7 clinical research centers. Construct validity of the bladder health scales and function indices was guided by a multitrait-multimethod approach using health and condition-specific questionnaires, bladder diaries, expert ratings of bladder health, and noninvasive bladder function testing. Internal dimensional validity was evaluated using factor analysis; internal reliability was assessed using paired t-tests and 2-way mixed-effects intraclass correlation coefficient models. Chi-square, Fisher exact, or t-tests were used for mode comparisons. Convergent validity was evaluated using Pearson correlations with the external construct measures, and known-group validity was established with comparison of women known and unknown to be symptomatic of urinary conditions.

Results: The sample included 1072 participants. Factor analysis identified 10 scales, with Cronbach's alpha ranging from 0.74 to 0.94. Intraclass correlation coefficients of scales ranged from 0.55 to 0.94. Convergent validity of the 10 scales and 6 indices ranged from 0.52 to 0.83. Known-group validity was confirmed for all scales and indices. Item distribution was similar by mode of administration.

Conclusion: The paper and electronic forms of the bladder health scales and function indices are reliable and valid measures of bladder health for use in women's health research.

Trial registration: ClinicalTrials.gov NCT04016298.

Keywords: adaptive behavior; construct validity; instrument; lower urinary tract symptoms; multitrait-multimethod.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Cross-Sectional Studies
Female
Humans
Psychometrics / methods
Quality of Life*
Reproducibility of Results
Surveys and Questionnaires
Urinary Bladder*

Associated data

ClinicalTrials.gov/NCT04016298

Abstract

Publication types

MeSH terms

Associated data

Grants and funding